PRSFit.com Personal Best Fitness :: Marathon and Running Training Programs ::

Head Coach:

Jeff Kline, CET, CNA
email

Jeff is a Nationally Certified Endurance Trainer, a Sponsored Elite Triathlete and a veteran of many road races of all distances. As the founder of PRS Fit, Jeff instills in all the staff that each athlete we train, regardless of their level of experience, receives exactly the same personal treatment.

Free Health and Nutrition Evaluation

If you're a runner a triathlete or just looking to trim up and stay in shape. True fitness is understanding your body and it's needs. After completing this evaluation we will contact you via telephone or email (your choice) within 24 hours to go over the results, and give you the information you need to properly nourish and fuel your body.

This information will include;

Body Mass Index
Basal Metabolic Rate (the number of calories your body burns while at rest)
Total Daily Energy Expenditure (the number of calories you burn throughout your day)
Body Fat Percentage (if you have a tape measure we can give you a close estimate)
Lean Muscle Percentage

We will also discuss a plan of action based on your personal results, that will help you clearly define a solid nutrition plan to support your lifestyle and training.

Please complete the entire questionnaire and return for review. If you have any questions email us

About you :
Name:
Address:
City:
State:
Zip:
Gender:
Birth date:
Phone number:
Cell phone:
Email:
Height:
Weight:
Weight One Year Ago:

List your current activities.:

How much time do you exercise each day?:

Describe your work activities. This will help us establish how many calories you burn daily.:

Give medical history - names and dates of past ailments, operations (anything you feel is significant, including past complaints. :

Are you currently being treated for any illness?:

Please list any supplements you are currently taking include all vitamins and minerals, protein shakes etc..:

Home Body Fat Test No home body fat test is as accurate as having it done by your doctor or health club professional. But for the purposes of our evaluation, this test is reasonably accurate and convenient. All you need is a cloth tape to measure different parts of your body. This tape-measure test is used to estimate your percent body fat. It is usually quite accurate-- so if a man got 17 percent from this test, he could expect his true percent body fat to be anywhere between 15 and 19 percent. For some people, however, the results of the tape measure test may not come so close to their true percent body fat. People who are very, very fit can get numbers 3 to 5 percent higher than their true percent body fat. Because they don't have a lot of fat inside their muscles, very fit people may be lower in body fat than this tape measure test indicates. Conversely, if a person is skinny but not fit, this body fat test may yield a number 3 to 5 percent lower than his or her true percent body fat. Though they look thin, unfit skinny people really have more than the usual amount of fat inside their muscles, which you can't see from the outside. So, what's the bottom line? For many people, this tape measure test is quite accurate, it puts you in control, it can be done frequently and it costs nothing. The most valuable aspect is that you can test yourself and you can see change over time. Start by telling us your...
Age:
Current Weight:	lbs kg
Sex:	Male Female
Now, use a cloth tape measure to measure the circumference of the areas listed below. Enter the numbers in the appropriate box.


Waist:	in.	Stand up straight, but don't suck in your stomach. Measure the widest circumference.
Hips:	in.	Stand with your feet about 4 inches apart and measure the widest part of your hips.
For the remaining measurements use your dominant side. Measure the circumference of the areas listed below.
Forearm:	in.	Clench your fist so that your forearm is flexed. Measure the widest part between your wrist and elbow.
Calf:	in.	Place your weight on your dominant leg and measure your calf at its widest part - about half way between your knee and ankle.
Thigh:	in.	Stand with your feet about 12 inches apart. Measure your upper thigh at the widest part.
Wrist:	in.	Measure in the dip between the bony part of your wrist and the start of your hand.

Usual Food Choices

Please List in the boxes how often you eat these foods

Foods	Number of times weekly	Rarely or Never	Comments
Beverages
Milk
Fruit Juice
Soda Pop
Beer, wine or hard liquor
Lemonade or Kool-Aid
Sports drinks
Protein Drinks
Coffee or Tea
Protein Sources
Beef
Chicken
Pork
Fish
Peanut Butter
Beans (all beans)
Tofu or Soy Products
Yogurt
Cheese
Eggs
Carbohydrates
Bread, bagels, rolls
Pastas
Rice
Potatoes
Fruit
Fresh
Canned
Vegetables
Fresh
Canned
Others
Butter or Margarine
Salad dressings or Mayo
Oils
Nuts
Cheat Food, pizza, potato chips, ice cream, candy, or cakes

List 10 foods that you normally buy when you go to the grocery store.

What specific information would you like to learn about about managing your personal nutrition.

Are you currently following a special weight management program? Be specific.

Please record the foods and beverages you ate for the last 2 days. How much of each? (cup, oz. etc.)How was it prepared? (grilled, fried, etc.)

Day One

Morning /Time	Midday/Time	Evening/Time	Snacks

Day Two

Morning /Time	Midday/Time	Evening/Time	Snacks

Thank you for taking the time to fill out your personal nutrition evaluation. After carefully evaluating the information one of our nutrition and wellness coaches will contact you. Please select the way you would like to be contacted.

Telephone. Please give a number and best time for you.

E-mail.

Live Healthy, Have Fun, Train Smart

The Coach